Test of an Interactive Voice Response Intervention to Improve Adherence to Controller Medications in Adults with Asthma

Abstract

Objective: This study was conducted to test the effectiveness of a theory-based interactive voice response (IVR) intervention to improve adherence to controller medications among adults with asthma.Methods: Fifty participants aged 18 to 65 years who had a physician diagnosis of asthma and a prescription for a daily inhaled corticosteroid, attended a baseline visit and a final visit 10 weeks later. Participants randomized to the intervention group received 2 automated IVR telephone calls separated by one month, with one additional call if they reported recent symptoms of poorly controlled disease or failure to fill a prescription. Calls were completed in less than 5 minutes and included content designed to inquire about asthma symptoms, deliver core educational messages, encourage refilling of inhaled corticosteroid prescriptions, and increase communication with providers. Adherence was tracked during 10 weeks, with objective measures that included either electronic monitors or calculation of canister weight. Participants completed the Asthma Quality of Life Questionnaire, the Asthma Control Test, and the Beliefs in Medications Questionnaire (BMQ) during both visits.Results: Adherence was 32% higher among patients in the IVR group than those in the control group (P ‫؍‬ . Patients often do not adhere to treatments for chronic health conditions, with the consequence that many conditions are poorly controlled. In the treatment of asthma, fewer than half of prescribed daily controller medication is typically taken by patients.1,2 In a report about refill patterns among 5500 patients with asthma, only 43% filled their inhaled corticosteroid more than once during 12 months. 3 In another study, each 25% decrease in refilled medication was accompanied by a doubling of the hospitalization rate. 2 Adherence rates among children are similarly poor 4,5 and remain so even in the face of recent exacerbation. 6 Considerable attention has been directed at changing health behavior and increasing adherence to treatments for chronic health conditions. The World Health Organization in 2003 published a call for action to improve treatment adherence across diseases, continents, and cultures, 7 and the This article was externally peer reviewed.

The E-Coach technology-assisted care transition system: a pragmatic randomized trial

“…In IVR systems, human voice is replaced by an interactive, recorded script which respondents provide answers to by pressing keys on the touchpad of a phone [14]. IVRs have demonstrated some efficacy in chronic disease management, including screening, preventive services, and medication adherence [15][16][17]. IVR can obtain information from patients, deliver tailored instructions, and allow for remote monitoring [18].…”

“…IVR can obtain information from patients, deliver tailored instructions, and allow for remote monitoring [18]. Previous studies of IVR interventions have used quasi-experimental designs [19,20] and clinical trials [16,21] but have had mixed results; very little rigorous work has been done to evaluate IVR interventions focused on care transitions; thus a rigorous, real-world study of an IVR-based intervention to support care transitions in congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) was needed.…”

Theory-Based Digital Interventions to Improve Asthma Self-Management Outcomes: Systematic Review (Preprint)

“…1). Of these 16 studies, 11 (69%) reported on randomised controlled trials (RCT) (10 two-arm RCTs [50][51][52][53][54][55][56][57][58][59], one three-arm RCT [60]) and 5 (31%) were feasibility studies employing a pre-post design [61][62][63][64][65] (Multimedia Apendix 2). Two of the RCTs reported on the same intervention [51,59], however, as they reported on different outcomes, and different uses of theory, we have considered them as separate interventions.…”

“…Three studies measured adherence using electronic monitoring [52,60,61] while 2 used self-report [54,58]. All studies reported a significant positive effect of the intervention on adherence.…”

“…Most studies were undertaken in the United States (75%; n=12; [51-56, 59-61, 63-65]), followed by Australia (n=2; [57,62]), Canada (n=1; [50]) and New Zealand (n=1; [58]). Studies included a range of ages: children (44%; n=7; [51, 53, 59-61, 64, 65]), adolescents (13%; n=2; [54,55]), adults (38%; n=6; [50,52,57,58,62,63]) and mixed sample (6%; n=1; [56]). Between 35-82% of the samples were female.…”